A giant spontaneous subcapsular hematoma of the liver revealing a COVID-19 infection, a coincidence? (A case report).

Hemorrhagic manifestations during COVID-19 infections are increasingly described in the literature. We report the first case of spontaneous subcapsular hematoma of the liver revealing a COVID-19 infection in a 44-year-old woman with no underlying health condition history, a computerized tomography evaluation showed an aspect of lung ground-glass opacities, with moderate impairment estimated at about 20%. Reverse transcription-polymerase chain reaction confirmed the diagnosis of COVID-19 infection. During the COVID-19 pandemic, non-traumatic bleeding such as spontaneous hematomas in patients with no coagulation disorder could be a manifestation of COVID-19 infection.

Factors influencing the occurrence of biliary stricture above the confluence in major bile ducts injuries: Analysis of a case series.

BACKGROUND: bile duct injury is a complication that occurs mainly after cholecystectomy. Outcomes of biliary repair surgery are worse when the stricture level is above the biliary confluence. METHOD: A single centred retrospective study was carried out on patients operated in our department for biliary stricture after a major bile duct injury over the period from January 2010 to May 2018. Only patients operated for biliary stricture were included. This study aimed to determine the independent factors influencing the occurrence of a stricture above de biliary confluence. Univariate and multivariate binary regression was used for data analysis. RESULTS: Fifty-three patients were included, they were 43 women and 10 men, sex-ratio was 0.23. Thirty-one patients had Grade E3-E4-E5 stricture (58,5%), and patients who had a failure of a previous repair surgery accounted for 36% (n = 19) of our patients.After univariate and multivariate analysis, only laparoscopic cholecystectomy (OR = 7.58, CI = [1.47-38, 91], P = 0.015) and failure of anterior biliary repair surgery (OR = 7, 12, CI = [1.29-39.42], P = 0.025) were independent factors associated with more frequent occurrence of biliary strictures above the confluence. CONCLUSION: Failure of biliary repair surgery makes the pre-existing biliary stricture progress and compromises subsequent surgery's outcomes. It is important to refer all cases of bile duct injury to specialized centers to increase the chances of success of the first biliary repair surgery.

Laparoscopic management of a drain site evisceration of the vermiform appendix, a case report.

INTRODUCTION: Peritoneal cavity drainage is not riskless and several publications reported drain induced complications. However, till this day, abdominal drainage is still a subject of divergence between necessity and usual operative practice. We describe in this publication an exceptional complication of drainage, which is the drain site evisceration of the appendix. CASE PRESENTATION: We report the case of a 47-years-old patient, initially operated for perforated ulcer peritonitis, in whom an evisceration occured 48h after the removal of an intraperitoneal drain placed in the Douglas pouch, the physical examination predicated the presence of a herniated omentum fringe, as a precaution a laparoscopic exploration was performed and revealed that the eviscerated organ was the vermiform appendix, then a two trocars appendectomy was performed and the orifice of the evisceration was safely closed. DISCUSSION: Since the first description in 1995, only seven cases were reported in the literature, we propose a new management of the drain site evisceration of the appendix, including laparoscopic exploration, and both side control of the drain site defect closure, our technique seems safer. CONCLUSION: The laparoscopic approaches must have a place in the management of the drain site eviscerations.

A spontaneous transomental hernia through the greater omentum.

Transomental hernia is the rarest form of internal hernias. Clinical expression of this pathology is ambiguous and diagnosis is often made at complication phase, after irreversible strangulation of the herniated loop. Radiological diagnosis is still difficult and intraoperative exploration usually allows discovering this pathology when patient is operated for acute intestinal obstruction. Treatment is surgical and aims to treat intestinal obstruction and prevent recurrence. We describe the case of a 65 years old male operated for a preoperatively suspected internal hernia; surgical exploration found a transomental hernia trough the greater omentum.